Imagine you wake up, with a foggy sense of relief, from a knee operation. In the six-month wait for surgery, you had almost grown used to the pain and loss of mobility. Now, you think, recovery begins.

Your relief turns to stunned disbelief as you see the bandages on your left knee. It was your right knee that needed replacing!

Mistakes like this have a name: “never events”– events that should never happen. The Canadian Patient Safety Institute (CPSI) has drawn up a list of never events; operations on the wrong limb or body part, surgery on the wrong patient, foreign objects left inside a patient and fatal or severe reactions from allergies known to the patient. Also on the list are stage 3 or 4 pressure sores, commonly known as bed sores, that develop in the hospital.

Those with no experience of pressure sores may see them as an anomaly on the list. Is a bed sore really as severe as an operation on the wrong limb? Yes. Stage 3 and 4 pressure sores are open wounds that can damage tissue right to the bone and lead to serious complications such as bone or blood (sepsis) infections. They cause horrific pain and are notoriously difficult to heal. These sores are preventable — they’re caused by staying in one position too long.

CPSI is to be commended for making the list. There is a maxim among accountants: “what gets measured gets managed.” Naming, defining and reporting on never events should eliminate many of them. By definition, “never events” should never happen.

There’s just one problem: CPSI’s definition limits “never events” to hospitals. But stage 3 and 4 pressure sores also develop in long-term care homes. The Canadian Institute for Health Information reports on the worsening of pressure ulcers in long-term care. There is no stated expectation that these sores should never happen and, at an average national rate of 3.1 per cent (of patients having worsening sores since their last assessment) they are far from “never events” indeed.

As American abolitionist Frederick Douglass said “the limits of tyrants are prescribed by the endurance of those whom they oppress.” The same can be said of pressure sores. They are unwelcome and cruel, but nearly always preventable. They only happen in long-term care settings because we accept that residents must sometimes endure pain and suffering. We could instead have invested in the staffing and resources required to abolish these sores from long-term care homes as well as hospitals.

A recent report from British Columbia’s Seniors Advocate, called “Every Voice Counts,” found that voices of individuals in long-term care don’t count.

Survey results revealed only 43 per cent of B.C.’s long-term care residents were visited by a doctor always or most of the time when sick and 38 per cent were not consulted about their medications. Only 37 per cent of residents could always or most of the time bathe or shower when they wanted and only 45 per cent reported being able to spend time with like-minded residents.

These results must be taken alongside the positives of the report: over half of residents (57 per cent) said their care facility feels like home always or most of the time and most feel respected always or most of the time by staff (86 per cent) and by other residents (77 per cent).

Hospitals have promised zero tolerance for severe pressure sores and other never events; we must set similar standards for care facilities and red flag them when breached. Everyone, regardless of age, deserves to live out their life with dignity, respect and peace of mind — and without late stage pressure sores.

Grey Matters is a weekly column by Wanda Morris, the VP of Advocacy for CARP, a 300,000 member national, non-partisan, non-profit organization that advocates for financial security, improved health-care for Canadians as we age. Missed a week? Past columns by Wanda and other key CARP contributors can be found at carp.ca/blogs.

Jenkins, a renowned nutrition scientist, is the man behind the glycemic index, a measure of how fast and by how much foods raise blood sugar and insulin levels. It lies at the heart of a load of weight-loss diets, from Atkins to the Zone.

Unsurprisingly, Jenkins is pleased with drum beats coming from Health Canada that the next iteration of the food guide, due out in early 2018, will steer people to chickpeas over cheddar and encourage the consumption of plant, not animal-based proteins.

“I can understand — you have people saying, ‘What about the family farm?’ Well, to be honest, if somebody says that to you, have some sympathy also for the Maritimers” and others in the East, said Jenkins, a professor in the departments of nutritional sciences and medicine at the University of Toronto. After the cod fisheries were decimated in the 1990s, “Newfoundlanders had to leave, or think of something else,” Jenkins said.

Seventy-five years after Canada’s first official “food rules” debuted in wartime ads, the food guide is undergoing its first major overhaul in a decade with every sign it’s going to emerge leaning more vegan than omnivore.

The Dairy Farmers of Canada fret the “milk and alternatives” category will be removed from the guide entirely and lumped with plant-based foods into a single, protein-rich foods category. Animal-rights activists, meanwhile, are hailing the proposed principles framing the rewrite as a “huge win for the cows.” Others have accused the government of pushing an environmentalist agenda.

In its “guiding principles” for the food-rules rewrite, published earlier this year, Health Canada says it isn’t recommending people shun animal-based products and proteins altogether, but suggests it might be better for greenhouse-gas emissions and soil and water degradation if we did.

In an interview, Health Canada officials said they considered the “totality” of the evidence when they reviewed the scientific base for updated dietary guidance to Canadians.

Some argue that even the current recommended caps on saturated fat intake (less than 10 per cent of daily energy, or calories) are no longer justified by the latest evidence, and that even a relatively moderate intake of fruits, vegetables and legumes — three to four servings a day, half the current recommendation and a target that’s likely more achievable and affordable for many — is sufficient to lower a person’s risk of cardiovascular disease and death.

“The evidence for saturated fat has been very weak,” said McMaster University’s Andrew Mente, co-author of a large study published in August involving more than 135,000 people across five continents. The so-called PURE (Prospective Urban Rural Epidemiology) trial found those with a high intake of fat (35 per cent of daily calories) were 23 per cent less likely to die after an average seven years of follow-up than those with a low intake (less than 10 per cent of calories). Total fat and individual types of fat, including saturated fat, were not associated with risk of heart attacks or death due to cardiovascular disease.

It’s not quite the “Low-fat diet could kill you” story some British headlines claimed it was. However, “What we show is going to low levels (of saturated fat) can actually be harmful,” Mente said.

Dairy and red meat are the primary sources of saturated fat.

The PURE study also found people who consumed three to four servings of fruits, vegetables and legumes per day had the lowest risk of death, with little added benefit from eating more.

The study doesn’t prove cause and effect, only an association. And Mente says no one is advocating a very high-fat diet, either. He’s hoping to see moderation in the new food guide, “a little bit of all the food groups.”

However, he and others are questioning the “beans-over-beef” argument.

“So far, Health Canada hasn’t revealed what evidence they used to make that statement, so I think we’re all wondering,” said Stephanie Atkinson, a professor in the department of pediatrics at McMaster University who, like Jenkins, helped oversee the development of Canadian and U.S. dietary reference intakes.

“I think they really need to state the rationale for the emphasis on plant-based sources of protein, and have us understand how they linked that to diet-related disease.”

It’s also not clear how much plant-based versus animal. “It’s kind of wide open,” Atkinson said: 50 per cent? More?

Under Health Canada’s 2015 “evidence review,” there’s a brief reference to soy and lowered cholesterol. It also summarizes “convincing evidence” from systematic reviews linking red and processed meat with increased risks of colorectal cancer, and increased risks of heart attack and stroke with saturated fat. Fibre-rich foods, it notes, have been shown to decrease colorectal cancer risk.

Health Canada says it excluded studies produced by industry. “Let’s just say there is potential for either real or perceived conflict of interest for those sorts of reports,” said Hasan Hutchinson, director general of the office of nutrition policy and promotion.

“In reality, in my mind this is not very different than what our existing guidance is,” he says. For example, the current food guide recommends seven to 10 servings of fruits and vegetables daily for adults age 19 to 50, depending on gender, and only two to three servings of meat and alternatives, “and even there we’re recommending people go with meat alternatives,” Hutchinson said.

“We have for a long time been talking about very quite small amounts of animal food in the diet to start with.”

The government hasn’t yet decided what will be removed, renamed or regrouped, he added.

But people would be wrong to assume “that we are saying, ‘Have no dairy, have no meat,’” he said, noting the public consultation documents mention animal-based foods as well, such as eggs, fish, poultry, lean red meats and lower fat milk and yogurt.

Jenkins, a scientist at Li Ka Shing Knowledge Institute at St. Michael’s Hospital, says relatively few studies have been done in nutrition compared to drugs, but those that have strongly support moving to a more plant-based diet. “And anybody who says they’ve got a different answer is, I think, deceiving himself or herself.”

The best-controlled research on the subject, he said, is the PREDIMED study, which, in 2013, reported that a Mediterranean diet supplemented with either extra-virgin olive oil or nuts resulted in a 30-per-cent risk reduction in cardiovascular disease, compared with a low-fat diet.

He also believes the new food guide may better reflect the nation’s cultural diversity and the growing numbers of people migrating from non-milk-drinking, non-beef-eating parts of the world. “Are these people any worse for it in their native situation? No, but when they come to us, they get sick.”

Canadians are also already drinking less milk and consuming less red meat. And while animal proteins are more complete proteins than plant-based proteins, providing 100 per cent of the essential amino acids needed for skeletal muscle growth, Jenkins said that only becomes an issue if overall protein intakes are low. For the majority of Canadians, protein intakes are high.

There’s also nothing wrong with linking human health with environmental and humanitarian concerns, said British-born Jenkins, who turned vegetarian the year his aunt sent a Christmas hamper to his family. Inside were two bantam chickens, plucked and decapitated, that used to run wild on her English country estate. They had been Jenkins’s pets, won at a summer church fair. Jenkins used to play with them on his holidays.

“The question you should ask is, ‘is the diet they’re recommending going to be dangerous?’ No, I think it’s going to have great benefits,” he said, including potentially improved health, lower insulin resistance and reduced body weight.

Still, there’s little doubt any dumping of milk or other radical change would meet “tremendous resistance,” he said. (The guiding principles emphasize only “regular intake of water.” Milk is included in an asterisk). In today’s food guide, “milk is a big thing — adults should be drinking two or three glasses of milk per day. Should they? Should adults be having two glasses of an infant food a day, or three?

Clarification: This story has been updated to more accurately reflect David Jenkins’s comments on nutrition studies.

]]>http://nationalpost.com/health/health-canada-prepares-to-rewrite-the-food-guide/feed2GettyImages-650607142skirkeyHave most kids diagnosed with ADHD really just been suffering from a sleep disorder?http://nationalpost.com/health/have-most-kids-diagnosed-with-adhd-really-just-been-suffering-from-a-sleep-disorder
Thu, 21 Sep 2017 17:17:57 +0000https://nationalpostcom.wordpress.com?p=76641130&preview=true&preview_id=76641130]]>Over the past two decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behaviour and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause.

They’ve looked at genetics, brain development, exposure to lead, the push for early academics, and many other factors. But what if the answer to at least some cases of ADHD is more obvious?

What if, as a growing number of researchers are proposing, many kids today simply aren’t getting the sleep they need, leading to challenging behaviours that mimic ADHD?

t looks more and more like ADHD and sleeplessness are two sides of the same physiological and mental coin” source=”” /]

That provocative and controversial theory has been gaining momentum in recent years, with several studies suggesting strong links between ADHD and the length, timing and quality of sleep. In an era in which even toddlers know the words Netflix and Hulu, when demands for perfectionism extend to squirmy preschoolers and many elementary-age students juggle multiple extracurricular activities each day, one question is whether some kids are so stimulated or stressed that they are unable to sleep as much or as well as they should.

Growing evidence suggests that a segment of children with ADHD are misdiagnosed and actually suffer from insufficient sleep, insomnia, obstructed breathing or another known sleep disorder. But the most paradigm-challenging idea may be that ADHD may itself be a sleep disorder. If correct, this idea could fundamentally change the way ADHD is studied and treated.

The latest data on this topic, presented this month at the European College of Neuropsychopharmacology Conference in Paris, looked at people’s circadian rhythms – the natural cycle of how they sleep and wake. It showed that study subjects with ADHD had levels of the hormone melatonin that rose 1.5 hours later in the night than those without ADHD. As a result, they fell asleep later and got less sleep overall, with consequences for other body processes.

When the day and night rhythm is disturbed, explained researcher Sandra Kooij of the Vrije UniversiteitMedical Centre in Amsterdam, so are temperature, movement and the timing of meals. Each change can lead to inattentiveness and challenging behavior.

“[I]t looks more and more like ADHD and sleeplessness are two sides of the same physiological and mental coin,” Kooij said in her presentation.

Sleep problems fall into three categories: insufficient sleep, insomnia and disordered breathing. All are common among young children. Some studies estimate that their prevalence might be as high as 20 to 40 per cent in young children.

Karen Bonuck, a professor of family and social medicine at Albert Einstein College of Medicine in New York, is known for her work on a 2012 studyof 11,000 children published in the journal Pediatrics. It found that those with snoring, mouth breathing or apnea (in which a person’s breathing is interrupted during sleep) were 40 percent to 100 percent more likely than those without the sleep issues to have behaviors resembling ADHD by age 7.

“There’s a lot of evidence that sleep is a big factor in behavior in children,” Bonuck said in a recent interview.

Previous studies have shown that about 75 percent of people with ADHD have sleep disturbances and that the less sleep they get the more severe the symptoms. In one paper, scientists showed that a group of children with nighttime breathing issues who were diagnosed with ADHD no longer met the diagnostic criteria for the disorder after they had their adenoids or tonsils removed to treat the sleep problem.

Bonuck’s recent work, funded by the National Institutes of Health, involved an education campaign targeted at teachers, parents and children that used teddy bears and the classic book “Good Night, Moon” to encourage more sleep. When researchers were collecting baseline data before any interventions, she said, she was shocked to find that a number of preschool children were going to sleep at 11 p.m. or later but had to be up before 8 a.m. to go to school. They were getting less than nine hours of sleep, markedly less than the 10 to 13 hours the American Academy of Pediatrics recommends for children ages 3 to 5.

“I thought there was an error,” Bonuck recalled. “Challenging behavior is a huge problem in the classrooms on a national level, and the symptoms of lack of sleep can look a lot like the symptoms of ADHD.”

William Pelham, a longtime ADHD specialist who directs the Center for Children and Families at Florida International University, agrees that some children are misdiagnosed as having ADHD when they actually have a sleep problem. Yet he said he has seen this only in a “handful” of cases out of thousands.

The link, he contends, is overstated and ADHD is a very real and potentially very serious diagnosis. According to the most recent survey by the Centers for Disease Control and Prevention, about 6.4 million children, or one out of every 10 children ages 4 to 17 in the country, have been diagnosed with ADHD, and he believes that the diagnosis is correct in most cases.

“Sleep is an issue for anything where you are trying to measure attention. But I don’t believe [it] . . . accounts for the vast majority of ADHD in the United States,” he said.

Still, Pelham has noticed an increasing number of children with ADHD and sleep issues in recent years. That has less to do with the nature of ADHD than with changes driven by the pharmaceutical industry, he said.

In the 1980s and 1990s, the most popular treatments were stimulants that acted only for four to six hours. Most kids now are taking ones that last 12 hours, he said.

“If you have kids who are sensitive to the medications. they might not be tired until midnight. So you have an increase in kids staying up later as a result of a societal shift of using the longest-acting medication,” he explained. Then, to counteract that in the evening, more children are taking yet another drug – “an antidepressant, melatonin or, God forbid, an antipsychotic,” he said.

]]>Teenager sleeping in front of a computer on a bednpwapoThis is why you should be cooking with yogurt – and not just for breakfasthttp://nationalpost.com/life/food/this-is-why-you-should-be-cooking-with-yogurt-and-not-just-for-breakfast
http://nationalpost.com/life/food/this-is-why-you-should-be-cooking-with-yogurt-and-not-just-for-breakfast#commentsThu, 21 Sep 2017 13:36:16 +0000http://nationalpost.com/?p=76298163]]>Our cookbook of the week is Yogurt Every Day: Healthy and Delicious Recipes for Breakfast, Lunch, Dinner and Dessert by registered dietitian Hubert Cormier. To try a recipe from the book, check out: braised beef shepherd’s pie; smoothie bowl with dragon fruit and lychee; and soft-boiled eggs and green pea salad.

Hubert Cormier has always been a yogurt lover. Although the vanilla-flavoured snack pack he loved as a child has since been replaced by protein-rich Greek-style.

From fresh salads to vibrant smoothie bowls, and the mashed potatoes atop his braised beef shepherd’s pie, the registered dietitian and author is expert at incorporating yogurt into pretty much anything. In his first English book, Yogurt Every Day (Appetite by Random House, 2017), Cormier highlights the versatile dairy product in 75 recipes.

Registered dietitian Hubert Cormier has written four books in French; Yogurt Every Day is his first in English.

Originally in French – Ma table festive: Yogourt (La Semaine, 2015) – the book was born out of his doctoral research at Laval University. Cormier and his team investigated the impact of yogurt consumption on the development of type 2 diabetes, heart disease or stroke (i.e. cardiometabolic risk factors).

“We found that yogurt consumers have a better diet quality overall. So, they will tend to eat more fresh products, fish, grains, fruit, vegetables and nuts,” he says.

The European Journal of Nutrition published their study but Cormier’s yogurt fascination was far from over. Excited by their findings, he created a user-friendly way to share them – a cookbook that enables people to include yogurt in their diets on a daily basis.

“In most recipes, we can cut fat and add protein by adding yogurt. That’s the principle,” Cormier says.

“This book was … to give (people) recipes to put yogurt everywhere, from breakfast to dinner to dessert to snacks. Not only as a dessert in their lunchbox in individual containers; to put it directly in their sandwiches and in their muffins.”

A take on pâté chinois – a Quebecois classic – Cormier adds yogurt and parsnips to his mashed potatoes.

For those new to making yogurt at home, Cormier offers several how-to options in the book: both with and without a yogurt maker; and using a slow cooker. He also includes instructions for plant-based versions such as soy and coconut.

“It’s really easy to make yogurt at home but you have to respect the right temperature and the time,” Cormier says. “It’s so simple to make because it’s just milk and bacteria: two ingredients.”

He writes that the main issue he sees in his nutrition clients is not overall protein consumption but rather an uneven distribution of it throughout the day. Often, he says, people eat the bulk of their protein at dinner – neglecting it in breakfasts and snacks. One solution, he says, is to add yogurt.

“Statistics Canada shows that the average yogurt consumption in Canada is not more than 100 grams of yogurt per week. That’s the equivalent of a small, individual-container serving size. And that’s not really (very much) versus all the health benefits it has to offer,” Cormier says.

He includes a useful substitutions table in the book, making it easy to swap out or modify ingredients in recipes already in your repertoire.

In Yogurt Every Day, Cormier includes the versatile dairy product in 75 recipes.

“It’s really a good substitute for any fat. That’s why we can put it in banana bread instead of oil or in other recipes (like) muffins. It really works perfectly,” Cormier says.

“Especially when the recipe requires some cream, sour cream or crème fraîche, we can always substitute by cutting half the cream and replacing it with yogurt.”

Cormier favours Greek yogurt because of its high protein content, and says that full-fat or higher-fat yogurt is a good choice because it’s more filling than low-fat.

“It’s important to remember that even if you choose full-fat yogurt, yogurt in general still remains a lower-fat option than ice cream, than cheese, butter or cream,” he says. “So, it’s a low-fat option even if it’s a full-fat yogurt.”

]]>http://nationalpost.com/life/food/this-is-why-you-should-be-cooking-with-yogurt-and-not-just-for-breakfast/feed3Yogurt Every DalbrehautHubert CormierBraised Beef Shepherd's PieYogurt Every Day by Hubert CormierResearchers urge caution over study linking fluoride exposure in pregnancy to lower IQs in childrenhttp://nationalpost.com/health/researchers-urge-caution-over-study-linking-fluoride-exposure-in-pregnancy-to-lower-iqs-in-children
http://nationalpost.com/health/researchers-urge-caution-over-study-linking-fluoride-exposure-in-pregnancy-to-lower-iqs-in-children#respondThu, 21 Sep 2017 03:55:47 +0000http://nationalpost.com/?p=76633028]]>Already there are people who claim fluoridated water is doing bad things to us. Now comes a new study suggesting a link between fluoride exposure in pregnancy and lower IQs in children.

Anti-fluoridation activists are calling it “the biggest moment in the history of this whole debate” and that any government that continues to add fluoride to tap water is condoning “one huge, awful human experiment.”

It’s exactly the response health policy experts — and some of the authors themselves — feared.

“There are some pretty bizarre theories out there, such as the idea that fluoride is being used to sedate the population,” said University of Alberta health policy researcher Tim Caulfield.

“I worry that this study — which the authors note should be replicated, and they call for further analysis and research — will be presented as definitive. It is not.”

In what is being described as the first study of its kind and size exploring fluoride exposure and different stages of brain development, University of Toronto-led researchers analyzed data from 287 mother-child pairs in Mexico City. The study recruited pregnant women from 1994 to 2005, and has followed the women and their children since.

The researchers measured fluoride in archived urine samples taken from the women when they were pregnant, as well as from their children when they were between ages six and 12.

Next they looked at how levels of fluoride in urine related to how children scored on intelligence and neurocognitive function tests when they were four, and again when they were between six and 12.

Children scored 2.5 to three points lower on IQ tests for every 0.5 milligram-per-litre increase in their mother’s urinary fluoride levels beyond 0.8 mg/L.

There was no clear association between IQ scores and values below 0.8 mg/L. As well, the children’s own urinary fluoride levels, measured when they were being tested, didn’t seem to have a significant effect.

That suggests that whatever effect fluoride might have on brain development occurs in the womb.

In Canada and the U.S., most fluoride exposure comes from the fluoridation of drinking water to prevent cavities, and fluoride in toothpaste and other dental products.

In Mexico, “not many people drink tap water,” said Dr. Howard Hu, the study’s principal investigator and founding dean of the University of Toronto’s Dalla Lana School of Public Health. Instead, the women were exposed to fluoridated salt. In 1991, that country became the seventh in the world to introduce a national salt fluoridation program to prevent cavities.

The researchers adjusted for numerous “confounders,” including the baby’s birth weight, the mother’s smoking history, IQ, socioeconomic status and lead exposure.

The Mexican mothers had, on average, 0.90 milligrams per litre of fluoride in their stored urine, which the researchers said is in the “general range of exposures” reported for other populations.

According to Hu, one 2012-2013 survey showed the mean urinary fluoride levels for Canadians were about 0.43 milligrams per litre, about half the Mexican levels.

However, the findings may mean that “there still may be a level of fluoride exposure among both pregnant women and everybody else that can still preserve the beneficial effects on tooth decay, while avoiding any effects on intelligence,” Hu said.

The paper adds to studies that have been trickling out of China hinting that fluoride may be neurotoxic to children exposed to exceptionally high levels of fluoridated water. Rat studies have shown fluoride can accumulate in rat brain tissue after chronic exposure to high levels, Hu and his colleagues from the National Institute of Public Health of Mexico, University of Michigan, McGill University, Indiana University, Mount Sinai School of Medicine and Harvard School of Public Health write in the journal, Environmental Health Perspectives. A 2006 report by the U.S. National Research Council, meanwhile, also cited experimental and epidemiological evidence that fluoride may retard neurodevelopment.

“It’s clear from human studies that fluoride can cross the human placenta without a problem,” Hu said, adding that animal studies suggest it collects in the hippocampus, important for learning and memory.

The team cautions their findings need to be confirmed in other populations. And Hu said it’s hard to make direct comparisons with women in the U.S. or Canada, where there haven’t been large population studies of maternal urinary fluoride levels.

But he said the study raises a red flag. “This is a very rigorous epidemiology study. You just can’t deny it. It’s directly related to whether fluoride is a risk for the neurodevelopment of children. So, to say it has no relevance to the folks in the U.S. seems disingenuous.”

In a statement, the American Dental Association said the findings “are not applicable” to the U.S. “Because it’s not known how the subjects of the study ingested the fluoride — whether through salt, water or both — no conclusions can be drawn regarding the effects of community water fluoridation in the U.S.,” the ADA said, adding that more than seven decades of research have shown fluoridation is safe and helps prevents cavities.

Across Canada, where fluoride was first added to public drinking water in the 1940s, numerous cities, including Ottawa, Edmonton and Toronto, still fluoridate their water in keeping with guidelines from Health Canada. Others like Calgary, Waterloo and Windsor have been taking it out.

Opponents claim fluoridation causes, among other things, heart disease, cancer, birth defects, kidney problems, goiters, ulcers, anemia and spontaneous abortion. “However, these associations are not supported by the scientific literature,” University of Guelph researchers wrote in a 2014 evidence review for the National Collaborating Centre for Environmental Health.

Paul Connett begs to differ. “Why would anybody rate the equivalency or supremacy of reducing tooth decay by about one cavity a lifetime when what’s at stake is the mental development of your children? It’s utterly preposterous,” said Connett, executive director of the Fluoride Action Network.

Excess amounts of fluoride can cause dental fluorosis, which causes teeth staining and pitting. “You can see it with the naked eye,” Connett said. “What we’ve also said is, what’s happening to the developing baby’s tissues? What is happening to the brain, the thyroid? Now we’ve got the evidence. It says you are lowering the IQ of your children.”

The paper concludes no such thing, the University of Alberta’s Caulfield argues: it’s just a correlation, not a cause of effect.

Hu said the research team, and the paper’s publisher, expected the findings would stoke the fluoride debate. “We’re going to stay out of that policy question. We prefer to just stick to the science,” he said.

But he gets the controversy.

“If you just Google ‘fluoride’ and ‘water,’ you’ll see lots of public health agencies saying this is really important for dental health and that the science suggesting it’s a problem is weak,” Hu said.

“But then there are these anti-fluoridation groups that say these are Nazis trying to kill us, and they’re denying the evidence and fluoride is just another of the various poisons that governments are subjecting us to without regard for our children.”

However, he said the science base for fluoride having an impact on health such as neurodevelopment at the levels of exposure seen with fluoridated water in the U.S. and Canada has been weak and spotty.

“Naturally it’s controversial, because anything that involves government making a decision for you — ‘I’m going to put fluoride in your water whether you like it or not’ — is so antithetical to a lot of what Americans believe,” Hu said.

“I think in the U.S. in particular there has been a very loud feeling that there’s some evidence it may not be the best thing.”

McMaster University in Hamilton, Ont., is planning to ban smoking on campus by 2018, making it the first Ontario post-secondary institution to issue a prohibition on the use of tobacco and soon-to-be-legal marijuana on its grounds. Allowing smoking to go on any longer would have been at odds with what the school said was “globally recognized” research in the health and “societal well-being.” University president Patrick Deane said the ban was a next step in “fulfilling our responsibilities as educators.”

Not even in your car

McMaster said the new rule — which was apparently written with input from students — not only covers all the university’s outdoor properties, but also any private vehicles parked on campus. That provision is meant to protect passing students, staff and faculty from second-hand smoke, dean of students Sean Van Koughnett told the Canadian Press. The school said it would make exceptions on request, recognizing “the unique relationship that many Indigenous cultures have with traditional and sacred medicines.” Van Koughnett gave Indigenous smudging ceremonies as an example.

The punishment

The university will gradually phase in its enforcement efforts on the ban, starting on Jan. 1, 2018. For the first few months, scofflaws will be slapped with a referral to “a cessation program or given access to supports and resources.”

A preemptive strike on legal weed

The university said those who need marijuana for therapeutic purposes will still be included in the ban, but suggested that they try using edible products. With the federal government expected to legalize weed next year, the Canadian Cancer Society said it expects the smoke-free campus movement to accelerate.

Canada’s 14th smoke-free campus

Of the few colleges and universities to fully ban smoking, most are concentrated on the East Coast. Dalhousie University in Halifax was among the first to take the step in 2003. Yukon is the only province or territory requiring campuses to be smoke-free. And in Quebec, legislation set to take effect in November will require all its post-secondary schools to at least implement a smoking policy.

National Post staff and The Canadian Press

]]>http://nationalpost.com/health/mcmaster-university-campus-is-going-100-per-cent-smoke-free-here-are-five-things-to-know/feed0McMaster-1nationalpoststaffOntario study to lift six-month-sober rule for liver transplant patientshttp://nationalpost.com/health/ontario-study-to-lift-six-month-sober-rule-for-liver-transplant-patients
http://nationalpost.com/health/ontario-study-to-lift-six-month-sober-rule-for-liver-transplant-patients#commentsMon, 18 Sep 2017 20:37:14 +0000http://nationalpost.com/?p=76564435]]>Debra Selkirk’s chances did not look good. Without a lawyer, without any legal training, she decided to take on the Ontario government in a constitutional fight over a difficult cause — whether patients should be denied desperately needed liver transplants because of their drinking.

But two years later, fuelled by love for her late husband and “blind determination,” Selkirk has achieved a surprising victory.

The agency that oversees Ontario’s transplant system has agreed to run a pilot project that will make patients with alcoholic liver disease eligible for a transplant — without first having to be sober for six months.

Individual hospitals in the U.S. and Europe have tried similar experiments. But the Trillium Gift of Life Network’s project may be the first effort by any large jurisdiction in the world to overturn the longstanding six-month abstinence rule, touted as a way to make best use of a scarce resource.

In a detailed plan, the provincial agency says over the study’s three years it expects to provide transplants to almost 100 patients with alcohol-related liver disease, starting next August.

Trillium has not committed to permanently trashing the six-month rule, but concedes that recent evidence suggests alcoholic liver-disease patients fare as well as others — even without the “arbitrary” half-year of sobriety.

At the same time, the document warns, the change could increase waits for liver transplants and might undermine public support for the program.

Selkirk sees shortcomings in the $3-million plan, but after months of frustrating legal tussling, she said she is happy to have at least temporarily changed what had seemed an immutable policy — one that proved fatal for her own husband.

“I’m very proud that up to 97 or 98 people will get the opportunity to have a new life,” she said. “And I’m very hopeful the practice will continue.”

Jennifer Long, a Trillium spokeswoman, confirmed the agency is finalizing the program and acquiring the needed funding. But she stressed the goal is just to “determine if there is an evidence-based basis to change the criteria,” and nothing is yet written in stone.

“In the interim, it is important for all Ontarians to know that the listing criteria for liver transplants remain unchanged,” Long said.

As a health issue, it’s hardly insignificant, with Statistics Canada estimating that more than 1,600 patients die yearly from alcoholic liver disease.

Among their number was Selkirk’s husband, Mark.

Mark Selkirk

The Toronto businessman enjoyed a moment of local fame in 2000, his fibreglass company making the moose sculptures that were decorated in a high-profile public art project. He had also battled a drinking problem for most of his adult life and in 2010 was diagnosed with advanced alcoholic hepatitis.

Doctors said a transplant could potentially save Selkirk, while his wife — who appeared to be a match as a donor — and other family members were willing to give up part of their livers for him.

But Toronto’s University Heath Network (UHN) refused to do the operation until he had been dry for six months. Two weeks after his diagnosis, Selkirk was dead.

As the Trillium document notes, the rule has been in place worldwide for a variety of reasons: the belief that a period of abstinence could in some instances remove the need for a transplant; the fear that transplant recipients will start drinking again and waste one of the donated organs; and worries that giving alcoholics transplants could undermine public support for organ donation.

Selkirk launched the constitutional challenge in 2015, arguing the policy violated constitutional rights to equal treatment, and to life, liberty and security of the person.

“When you love somebody so much and you see what injustice he faced, it makes you angry and determined enough to stop it from happening to other people,” she says.

And Selkirk argues there is simply no evidence to justify the six-month rule, a position endorsed by one of the world’s leading transplant surgeons.

In an affidavit, Dr. John Fung, chief of transplant surgery at the University of Chicago and a member of the U.S. government’s advisory panel on transplantation, cited a series of studies indicating that alcoholic-liver disease patients do well with transplanted organs and rarely revert to heavy drinking.

That research includes a study of Fung’s that looked at 4,000 liver transplants, concluding that as many or more alcoholic-liver patients were alive five years after receiving a new organ as others.

The official position of the American Association for the Study of Liver Disease and the American College of Gastroenterology is that alcohol-disease patients should be treated the same as other people with liver failure, Fung noted.

But, he said, “liver transplant policy in the U.S. continues to be driven in most centres by … poor public perception of alcohol addiction.”

Selkirk notes as well that one of the largest groups of patients currently eligible for transplants without restriction are those with non-alcoholic fatty liver disease — often caused by poor diet and lifestyle.

After an initial vigorous fight against the challenge, provincial lawyers approached Selkirk in May 2016 with a change of heart. She says they admitted the research did not necessarily bolster their position, and convinced her to put the case on hold while the transplant listing criteria were reviewed. They also paid for Selkirk to finally hire a lawyer.

A series of delays and backtracks by the government later prompted her to pull out of that agreement, but Trillium had meanwhile agreed to its study, to take place at Ontario’s two liver-transplant centres — UHN in Toronto and the London Health Sciences Centre.

Trillium plans to hire specialized psychiatrists, nurses and others to provide addiction treatment that it hopes will lessen the chance of a drinking remission.

It is projecting 26 to 39 alcoholic-liver-disease patients will be transplanted each year, at a cost of $38,000 each — about 10 to 15 per cent of total liver transplants now.

Selkirk says Trillium should also conduct an education campaign to counter the public’s prejudices and explain why it makes sense to ditch the six-month rule.

For her part, she is seeking a publisher for a book she’s writing about her crusade — Moose List: One Woman, Many Giants – and hopes to start a charity that will advocate for and support patients like her husband.

Michael Fenrick, the lawyer who now represents her, says he’s worried the project has too many loopholes, including simply the “great reluctance on the part of Trillium to do the right thing.”

But he is still stunned by what his client has accomplished, largely acting without professional help.

“Debra is one of the most amazing and dogged people I have ever encountered,” said Fenrick, who teaches constitutional law at York University’s law school. “She has managed to move the needle on this issue. It just needs to be moved further.”

My father-in-law was a bit of a rascal. Dad, as he asked me to call him, knew how to have fun.

I remember hearing how he “borrowed” a tank to impress a girl during his time with the British Army in Egypt before the war. He might have gotten away with it, too, except he drove the tank into a low bridge which didn’t survive the impact. Dad was busted from sergeant to private, losing two stripes and a chunk of his paycheque.

By the time I met him, he’d mellowed considerably. He’d even given up roaring through his village on a motorbike, but only because he could no longer lift his leg over the gas tank.

As Dad entered his 90s, things started to go wrong. After nursing his wife of many years through dementia (and in the process finally learning how to boil an egg and make a cup of tea) he too was afflicted with that dreaded disease. The first symptom was a personality change. This good-humoured, fun-loving man became angry, volatile and violent. Matters came to a head after he hit my sister-in-law.

Dad had always said the only way he was leaving his house was in a box. But he was unable to look after himself, and my brother and sister-in-law could no longer provide the care he needed. The only solution, it seemed, was a long-term care residence.

Dad moved, but he didn’t adjust. He was increasingly disoriented and his physical health deteriorated. He walked into the new residence with a cane but, once there, was made to use a wheelchair. This was a problem. He wheeled the chair into furniture, then into staff and other residents. To prevent him from injuring himself and others, the staff lifted the handles of his wheelchair onto a window ledge. He could no longer move his chair.

When Dad tried crawling out of the wheelchair, the staff strapped him in. Dad lived the final weeks of his life strapped to that chair. Death, thankfully, came soon after.

The sad thing is, Dad didn’t have to spend the last weeks and months of his life that way. There was another solution. Like many frail, elderly individuals, he didn’t just suffer from dementia and mobility problems; he had a host of other conditions. Conditions that were treated aggressively with surgery, antibiotics and other medications. Conditions that, left untreated, may have resulted in an earlier, gentler death.

Had we spent the time to hear Dad’s wishes, to let him think about how he wanted his life to end, he may well have declined much of the treatment he was given in the last few years of his life. He would have wanted to be pain-free and comfortable, but why treat a systemic infection with antibiotics when it could cheat dementia? Why take a flu shot when death has become a longed-for friend?

In Canada, as in the U.K., patients have the right to informed consent. We, or our substitute decision-makers if we are no longer capable of making our own decisions, can choose to refuse any test, procedure or medication. Furthermore, refusing a treatment doesn’t mean we will be abandoned; our health-care system is still required to provide comfort care to palliate our symptoms and ease our dying.

We have the right to say no. Treatment is always an option, never a requirement. But it is the default in our health-care system. Saying no takes planning and courage, but the stakes are high. It is, quite literally, a matter of life and death.

Wanda Morris is the VP of Advocacy for CARP, a 300,000 member national, non-partisan, non-profit organization that advocates for financial security, improved health care and freedom from ageism for Canadians as we age. Send questions to askwanda@carp.ca. To join CARP or learn more, call 1-800-363-9736 or visit carp.ca

One thing — an organ transplant — could save his life. But it’s not an option, a long-standing rule stipulating that such patients be sober six months before being considered for the procedure.

So in what appears to be an unprecedented legal tactic, Gallant plans to ask the courts next week for an injunction forcing provincial authorities to place him onto Ontario’s transplant list.

The 45-year-old’s lawyer, Michael Fenrick, said he’s unaware of any other attempt to have a Canadian made eligible for a transplant through judicial order.

The injunction request is part of a constitutional challenge of a policy Fenrick says has no foundation in science, but much to do with the stigma around drinking-related illness.

“This is really his only and best hope, sadly,” the lawyer said. “In order to be listed for a transplant in the first place, you’re likely in a situation where your life is in grave and imminent peril … People in this situation most often can’t wait six months.”

The court application, to be filed early next week, does not ask that Gallant be allowed to jump the queue for an organ, only be assessed under the same criteria as patients with other types of liver disease, said Fenrick.

“He doesn’t (necessarily) get an organ out of this, but at least he gets over that insurmountable hurdle created by the policy,” said the lawyer. “And maybe then his life will be saved.”

Officials with the Trillium Gift of Life Network, the provincial agency that oversees the transplant system in Ontario, were not available for comment Thursday.

Ontario and most other jurisdictions throughout the Western world follow a policy that requires patients suffering from advanced, alcohol-linked liver disease to be abstinent for six months before being considered for a transplant.

The oft-stated rationale is that patients would otherwise be likely to start drinking again after their operation, putting their new organ in danger and potentially squandering a scarce resource.

Transplant administrators also worry that opening the system wider might deter people from agreeing to donate organs.

But Fenrick said a growing body of evidence suggests alcoholic patients are just as likely to do well after a liver transplant as others, and that only a small percentage revert to drinking.

A 2013 journal paper by six Canadian experts called the policy discrimination, noting that even those who take up alcohol again consume small amounts that are unlikely to harm their new liver.

Fenrick argues the six-month abstinence rule violates constitutional equality rights — which bar discrimination on the basis of disability — and the right to life, liberty and security of the person.

Gallant — who has struggled with drinking for 20 years — was admitted to hospital in July suffering from jaundice, and eventually diagnosed with alcoholic cirrhosis of the liver, alcoholic hepatitis and related conditions.

He has been sober since July 8, but doctors told him early last month that he had a 75-per-cent chance of dying within six months if he doesn’t get a new liver.

His 74-year-old mother, a retired medical secretary who lost another son to bronchial pneumonia in 2013 and looks after a daughter with multiple sclerosis, is now also caring for Gallant at her home.

]]>http://nationalpost.com/health/recovering-alcoholic-to-launch-court-fight-against-rule-barring-him-from-life-saving-liver-transplant/feed1surgery-1blackwell2001‘This is the tip of the iceberg’: Health officials say no area of Canada is safe from opioid crisishttp://nationalpost.com/news/rising-hospitalizations-due-to-opioid-crisis-puts-burden-on-health-system-report
http://nationalpost.com/news/rising-hospitalizations-due-to-opioid-crisis-puts-burden-on-health-system-report#respondThu, 14 Sep 2017 15:01:16 +0000https://nationalpostcom.wordpress.com?p=76541690&preview=true&preview_id=76541690]]>

TORONTO — At least 2,816 Canadians died from opioid-related causes in 2016 and that number “will almost certainly” surpass 3,000 in 2017, the country’s chief public health officer predicted Thursday, as officials outlined the growing scope of the epidemic.

While the western provinces have been hardest-hit — there were 978 illicit drug overdose deaths in B.C. and 586 apparently opioid-related deaths in Alberta in 2016 — the numbers of people dying in Eastern Canada are also rising. For example, Ontario had 865 deaths last year and Nova Scotia had 53 as a result of opioid-related toxicity.

“No area of Canada is necessarily safe from this crisis,” Dr. Theresa Tam told a media briefing from Ottawa.

A portion of the label for OxyContin pills

Canadians aged 30 to 39 accounted for the highest proportion of deaths related to the potent narcotics, at 28 per cent overall, although the figures varied widely across the country.

“We are beginning to get a better picture of the kinds of drugs that are fuelling this epidemic,” said Tam, noting that illicit synthetic fentanyl and fentanyl-like drugs are a major driver of overdose deaths in the hardest-hit areas of the country.

Deaths involving fentanyl more than doubled in the first three months of 2017 compared to the same period in 2016, she said.

“We’re also seeing that this is not a crisis involving only opioids. Many of the overdoses involved a mix of substances. In fact, 84 per cent of apparent opioid-related deaths also involved a substance that was not an opioid, adding to the complexity in addressing the crisis.”

Those substances include alcohol, cocaine and benzodiazepines, a class of anti-anxiety drugs that includes Valium (diazepam) and Ativan (lorazepam).

Dr. Robert Strang, Nova Scotia’s chief public health officer, said the number of deaths from illicit opioid use varied widely across the country: in Alberta, 64 per cent involved fentanyl, while only 15 per cent of deaths in Nova Scotia were linked to the powerful drug.

“This data illustrated to us that we are facing two different but overlapping issues,” Strang said. “First, overdose deaths from prescription opioids and second, overdose deaths from illicit drugs laced with fentanyl or other synthetic opioids.”

In Atlantic Canada, most deaths were related to prescribed opioids, some of which may have been diverted to the black market from legitimate users with acute or chronic pain.

“But we are starting to see in 2016 that we had our first small number of deaths … where illicit fentanyl was part of the picture,” he said of Nova Scotia.

In a report released earlier Thursday, the Canadian Institute for Health Information (CIHI) warned the opioid crisis is having a significant impact on the health system as a growing number of Canadians seek emergency hospital care for overdoses.

In 2016-17, 16 Canadians a day were admitted to hospital for opioid toxicity, up from 13 per day two years earlier — a rise of almost 20 per cent.

That one-year hospitalization rate translates into more than 5,800 Canadians needing treatment.

The last decade has seen hospital admissions for opioid poisonings jump 53 per cent, with more than 40 per cent of that increase occurring in the last three years, CIHI reported.

“We found rates varied across the country, but interestingly they were generally lower in the largest cities, such as Toronto, Montreal and Vancouver,” said Michael Gaucher, director of pharmaceuticals and health workforce information services at CIHI.

That finding may reflect a different demographic in smaller urban centres such as Hamilton, Saskatoon and Victoria, where a higher proportion of residents may be seniors taking prescription opioids and where there may be greater availability of the drugs on the street, he said.

The CIHI report showed adults aged 45 to 64 and seniors 65 and older had the highest rates of hospital admissions for opioid toxicity over the last 10 years, but the fastest-growing rate was for youth and young adults aged 15 to 24.

About half of those admissions were due to accidental opioid poisonings; about one-third were intentional; and the cause of the remainder are unknown.

“With seniors, you seem to see higher rates of accidental poisonings, perhaps related to multiple medications that they may be on,” Brent Diverty, CIHI’s vice-president of programs, said in an earlier interview. “So they simply take the wrong dose.

“We see higher rates of intentional self-harm in younger folks.”

CIHI found intentional opioid overdoses were most prevalent among young people aged 15 to 24, accounting for 44 per cent of hospitalizations.

Still, the researchers also found escalating rates of accidental overdoses among younger people, which Diverty said may be linked to recreational use of illicit drugs, some of which may be laced with a synthetic opioid like fentanyl.

In data from Alberta, CIHI found emergency room visits related to heroin and synthetic opioid overdoses soared almost 10-fold in the last five years. Over that period, ER visits in Ontario for heroin poisoning rose almost four-fold, while visits for synthetic opioids more than doubled.

While CIHI doesn’t have a dollar figure for the cost to the health-care system, Diverty said people admitted for an opioid overdose spend longer than average in hospital and there are downstream costs for continuing treatment of complications.

Meanwhile Thursday, federal Health Minister Ginette Petitpas Taylor announced an additional $7.5-million grant aimed at fighting the opioid crisis as she toured an Ottawa substance abuse treatment centre run by the Shepherds of Good Hope, which has applied for approval as a supervised-injection site.

Shepherds’ president and CEO Deirdre Freiheit said the centre’s staff are “absolutely fatigued.”

“We would have had a handful of overdoses a year or two ago and now we’re seeing multiple overdoses every single day…. Nurses, peer support workers, frontline staff are all just absolutely overwhelmed with the number of interventions they’re making just to keep people alive every day,” she said.

“I think this is the tip of the iceberg and we need some help.”
With files from Joan Bryden in Ottawa

]]>http://nationalpost.com/news/rising-hospitalizations-due-to-opioid-crisis-puts-burden-on-health-system-report/feed0opioidcanadianpressnpA study found that chemicals in shaving cream could be altering men’s spermhttp://nationalpost.com/health/a-study-found-that-chemicals-in-shaving-cream-could-contribute-to-lower-sperm-counts
http://nationalpost.com/health/a-study-found-that-chemicals-in-shaving-cream-could-contribute-to-lower-sperm-counts#commentsTue, 12 Sep 2017 20:56:33 +0000http://nationalpost.com/?p=76518799]]>Scientists are warning men the compounds in their shaving cream may be causing subtle changes in their sperm, reducing their chances of becoming fathers.

The problem, they say, is a ubiquitous class of chemicals called phthalates found in, among other things, personal care products, as well as food packaging (most recently in some boxed mac n’ cheese products).

Phthalates appear to affect the DNA in sperm cells, not by changing the genes themselves, but by attaching little chemical “tags” that stick to some parts of a sperm cell’s DNA.

This can make genes more or less active than usual during sperm production, a change known as an epigenetic effect.

“There has always been this heavy concern in the past with expectant moms not smoking and not drinking, for example, to protect the fetus,” lead author Richard Pilsner, an environmental health scientist at the University of Massachusetts Amherst, said in a statement.

“In this study, we see that dad’s environmental health contributes to reproductive success.”

Spermatogenesis — sperm production — is a 72-day process, he added. “Our study shows that this preconception time-period may represent an important development window by which environmental exposures may influence sperm epigenetics, and in turn, early life development,” Pilsner said.

“So, in the same way mom needs to be careful, dad also needs to.”

There’s longstanding evidence of sperm changes through epigenetics, but phthalates appear to be a new source and may be contributing to an apparent global slump in sperm counts.

In July, researchers reported a 52.4-per-cent drop in sperm concentration, and a 59.3-per-cent decline in total sperm count among men from Western countries (North America, Europe, Australia and New Zealand), with no sign of a levelling-off in recent years.

Phthalates are known hormone disrupters and are “pervasive environmental contaminants,” Pilsner and his co-authors wrote in the journal Human Reproduction. The chemicals have been linked with decreased sperm counts and motility, and increased sperm DNA damage. They have also been known to decrease testosterone in early fetal life at the time the genitals are forming.

The new study involved 48 men undergoing IVF with their female partners. Most were white, over age 30 and overweight; four were current smokers. Although all were seeking fertility treatment, only 12 had been diagnosed with male factor infertility. During IVF, eggs are retrieved from the woman, mixed with her partner’s sperm and the resulting embryos transferred back to her uterus.

Each of the men provided a semen sample the same day of egg retrieval. They also provided a urine sample, which was analyzed for eight different phthalate concentrations. The researchers also analyzed DNA extracted from sperm left over after IVF.

“What’s unique about this study,” Pilsner said in an interview, “is that we actually are getting the same semen sample that’s fertilizing the egg to create an embryo.”

After adjusting for age, BMI and whether or not the men smoked, the team found higher concentrations of phthalate metabolites were associated with sperm DNA methylation on 131 regions of a sperm cell’s genome, notably genes related to growth, development and “basic cellular function,” the team writes.

With methylation, molecules attach themselves to our DNA, acting like “dimmer” switches, usually lowering the activity of genes. These changes can be passed down to our children.

Most of the phthalates were known, or suspected testosterone blockers.

The phthalate-associated changes in sperm DNA also appeared to affect the quality of blastocysts, or days-old embryos. That suggests that could affect early-life development.

The researchers warn the study sample was modest (just 48 men) and that more research is needed to replicate their findings.

Sperm, to fully mature, takes a little under three months, Pilsner said. That offers time for these “methyl tags” to be modified or changed. “So, the message is, if you’re planning on getting pregnant, men may have an environmental responsibility prior to conception,” he said.

Phthalates are used to stabilize the scents in personal care products like body sprays, colognes, shampoo and shaving cream. “Maybe consider avoiding those,” Pilsner said. “There’s a good likelihood you’re getting a decent dose of phthalates.”

]]>http://nationalpost.com/health/a-study-found-that-chemicals-in-shaving-cream-could-contribute-to-lower-sperm-counts/feed6GettyImages-821406732skirkeyOttawa proposes making OTC codeine pills prescription-only after years of pressurehttp://nationalpost.com/health/ottawa-proposes-making-otc-codeine-pills-prescription-only-after-years-of-pressure
http://nationalpost.com/health/ottawa-proposes-making-otc-codeine-pills-prescription-only-after-years-of-pressure#respondMon, 11 Sep 2017 21:27:30 +0000http://nationalpost.com/?p=76516493]]>The federal government is proposing to end what one pharmacist has called the ”dirty little secret” of Canadian drug policy, requiring a prescription for codeine-containing drugs that are now freely available over the counter.

The suggested change would put a damper on products with sales of 600 million pills a year — 20 tablets for every Canadian — and a non-prescription status virtually unique in the industrialized world.

In a notice of the possible new rules, the government cites the surprising addiction toll exacted by the low doses of codeine in medicines that combine the opioid with acetaminophen or other painkillers.

About 500 people a year are admitted just to publicly funded addiction-treatment centres because they’re hooked on non-prescription codeine alone, and another 800 because of addiction to low-dose codeine plus other drugs, the department says.

A leading Canadian expert on drug policy says the pills are almost as dangerous for another reason, too: people who pop them for the high are consuming large amounts of acetaminophen or ASA, both drugs that can be highly toxic in bulk.

Pharmacists and other experts have called for this change since long before the current opioid-addiction epidemic — to little effect until now, said Dr. David Juurlink, a physician and toxicologist at Toronto’s Sunnybrook Health Sciences Centre.

“It’s a no-brainer, and it should have been done years ago,” he said. “It’s a distinctly unwise and inadvisable thing to allow.”

Juurlink is blunt in assessing why the department has taken so long to act: “Inertia and bureaucratic ineptitude, the two things Health Canada does best.”

The proposal was published in the Canada Gazette and is open to a 60-day comment period, after which time the government will decide whether to pass a regulation implementing the change.

The most common of the targeted products are generic versions of Tylenol 1 — codeine and acetaminophen — and “222s” — codeine and aspirin — which are no longer available as the brand-name original.

Canada is close to the world leader in codeine use, its consumption several times higher than most other Western countries, with only Iceland reporting a bigger habit per capita.

For those with a dependency problem and serious about getting the maximum benefit, numerous websites explain in detail how to extract the codeine.

Health Canada says making the low-dose codeine drugs prescription-only might lead to more use of the health-care system as patients wanting them would have to see a doctor. It could also drive abusers to more dangerous alternatives.

But it would also ensure that Canadians carefully consider with their doctor the best drug for their needs, said the notice. It noted, in fact, that over-the-counter codeine pills are of questionable effectiveness, with one 2010 review finding non-opioid alternatives worked better than codeine.

In fact, the dose in those tablets is virtually non-therapeutic, said Juurlink. While it is derived from opium, codeine has to be converted to morphine by the liver, so the resulting concentration also differs from person to person, he said.

Benedikt Fischer, an addictions scientist at Toronto-based Centre for Addictions and Mental Health, agreed the proposed change is long overdue.

But he warned that the risk of “displacement” — users moving to a more potent alternative — is real and has a recent precedent. When OxyContin was essentially taken off the market in Canada, many prescribers, patients and abusers switched to the much more powerful and perilous Fentanyl, he said.

If the codeine pills are made prescription-only, authorities should make sure to educate people about less-harmful pain-relief options, he said.

“There are potential hidden, unintended side effects of such a restriction that we need to monitor,” said Fischer.

Experts say the proposal would almost certainly reduce the market for the pills, but the trade group for Canada’s brand-name drug makers gave its stamp of approval Monday.

Innovative Medicines Canada supports the government’s low-dose codeine consultation and other efforts to counter the opioid crisis, Pamela Fralick, the group’s president, said in a statement.

In fact, most over-the-counter codeine pills sold now are generics, said Juurlink, so the brand-name industry has little to lose.

One of the most recent attempts to get the rules changed was a petition launched by pharmacists earlier this year. One of its supporters, former Edmonton hospital pharmacist Joe Blais, called the policy a dirty secret. “It’s time for our love affair with easily accessible codeine to stop,” he argued in a January blog post.

A few weeks ago, my husband and I walked to the Nooksack River falls near Mt. Baker, Wash. Nearby was a plaque detailing the history of the dam, including how the Bellingham Business Improvement Company filed a mining claim for the land around 1900. The company always intended to use the land for power generation, but the mining claim offered much cheaper access to the property.

It is 120 years later, and some things haven’t changed. Many business people see their work as a game to be won by exploiting tax loopholes, making deals with government officials or side-stepping labour laws. Businesses (almost always), stick to the rules but, within those rules, anything goes. It’s not that companies or their management are evil, they are just working in a system that rewards profit-making rather than fairness.

This is why it is critical that we have clear, bullet-proof legislation to protect those at risk from businesses and their profits-first cultures. This is why CARP is demanding better laws to protect corporate pensioners.

A pension is a deal between employees and their company. Employees accept a smaller paycheque in exchange for a pension down the road. The workers make all the sacrifice up front, leaving them vulnerable to corporate lawyers and managers seeking to cut costs or maximize profit later on.

Sears is seeking bankruptcy protection and pensioners are at risk of losing a chunk of their pensions, even though they held up their end of the bargain for years. Sears pensioner Robert Regnier shared this:
“I think about the many extra hours that I put into this company (Sears), and how I am being thanked for it. I remember organizing trade shows and working in excess of 100 hours in a week to make sure things ran smoothly. The extra nights, the calls after midnight to check alarms after being notified of a possible break in. I could go on and on and list the days and weeks of extra time I was asked to be in the store and was never paid or given time off for.”

After 39 years with Sears, Robert risks losing the unfunded amount of his pension, $2,900 a year (as well as $2,100 per year in health and dental benefits and a $15,000 life-insurance policy). Robert is just one of the 16,000 Sears’ pensioners whose financial security is being hit by a $300 million shortfall in Sears’ pension funding, and one of the 1.2 million corporate pensioners across this country whose financial security is at risk under our current laws.

Sears pensioner Robert Regnier shared this: ‘I think about the many extra hours that I put into this company (Sears), and how I am being thanked for it.’ (Photo courtesy Robert Regnier)

This isn’t just unfair to Robert and his colleagues; it’s unfair to the rest of us too. When corporations walk away from their pension commitments, pensioners are all too often forced to turn to government programs to help make ends meet – and taxpayers are on the hook. Like other companies before it, Sears is trying to stop funding its pension plan. The company has argued before a judge that making pension payments will leave it less sustainable in the future or less attractive to a new purchaser, and this might put it out of business. That explanation doesn’t cut it. If Sears’ management wanted to be sustainable or attractive to a new purchaser, they should have kept the business together rather than selling off key assets and using the proceeds to pay over $450 million in dividends to their U.S. owner.

Stand up for pensioners today. Sign our petition at carp.ca/pensioners. Pensioners have upheld their part of the bargain. Tell the federal government to make businesses live up to theirs.

Wanda Morris is the VP of Advocacy for CARP, a 300,000-member national, non-partisan, non-profit organization that advocates for financial security, improved health-care and freedom from ageism for Canadians as we age. Send questions to askwanda@carp.ca. To join CARP or learn more, call 1-800-363-9736 or visit carp.ca

By now, the centenarians need only sit on their doorsteps and wait for the tourists, who line up to hand them little red envelopes of cash and take pictures. They are the main draw, after all, in what’s come to be known as “longevity village,” a community in southern China’s remote Bama region, where the number of residents aged 100-plus is about five times the national average.

In addition to visiting centenarians themselves (a sign at the entrance to the village maps out their houses), tourists can buy bottled “longevity water,” lie down in a nearby cave said to have healing powers or breathe the clean air at an “oxygen bar.” There’s a construction boom, too, catering to those making longer stays.

The appeal is obvious. China has one of the fastest growing populations of old people in the world, and thanks to the “one child” policy there are fewer children to care for them. Living healthy, longer, is critical.

There’s just one problem: a number of experts have found little to support Bama’s claims as a “longevity hub.” Demographers report questionable documentation of the area’s centenarians, and some say they suspect many of the elderly greeting visitors in “longevity village” simply moved to there in their old age.

“It’s a bit like a gerontological park,” says Michel Poulain.

Ushi Okushima, 100, an elderly resident of Ogimi, Okinawa, Japan, is seen in her home in this file photo

Poulain is a Belgian demographer who co-authored the first study of what is called a “blue zone” – a geographic area whose population enjoys extraordinary longevity. In two villages in Sardinia, for example, there is one centenarian for every 1,000 people (versus claims of about 1 for every 3,000 in Bama).

Poulain has helped discover three other pockets of longevity: Okinawa in Japan, Nicoya in Costa Rica, and Ikaria in Greece. In 2010, after hearing of colleagues who had visited the centenarians of Bama, he also made a trip there. What he found, though, was that it was impossible to verify the ages of local centenarians.

Michel Poulain, demographer

For his research, Poulain has strict verification criteria, including checks from a number of official sources. In Bama, many locals were born before there were government birth certificates, or had only basic identification cards. “All we can do is check them based on the age of their children and the coherence of their claims,” he says.

Bama is also made up mostly of ethnic minorities (the Yao and Zhuang being predominant) who, according to Longevity: To the Limits and Beyond, do not keep track of their own birth dates even anecdotally. “(T)he reports of minority Chinese centenarians are mostly not true,” the book states, “because they seriously overstated their age.”

James Vaupel, one of the book’s authors, is the founding director of the Max Planck Institute of Demographic Research in Germany and a professor at Duke University in North Carolina. He also encountered verification problems visiting Bama back in the late 1990s. A woman claiming to be 107, for example, told him that her second child of six was 65 – which would mean she had four more children after the age of 42. Another “local” had, in fact, come to Bama from another town.

The biggest red flag for both demographers, however, is what they describe as the “abnormal” distribution of centenarians in Bama. Normally, there should be a majority of centenarians in their early 100s, then just a few who are older – 104 or 106. “Centenarians have a one in three chance of dying every year. So when you have the same number of 105-year-olds as 100-year-olds, you know something’s up,” says Vaupel.

Bama is just one of several areas in China that have proclaimed themselves longevity hubs. Jean-Marie Robine, the director of research for the French national health institute INSERM and one of the founders of the International Database on Longevity, has received invitations to visit a number of them. He’s also been to Bama, where he says he found “no evidence at all” for claims of unusually long life.

“They’re all getting the same ideas of what they can put in their flyers to explain their exceptional longevity (by) reading National Geographic,” he says.

These “explanations” often include clean air (a scarce resource in many polluted Chinese cities), “miraculous” local water and local habits like eating home-grown food and exercising regularly. But as Vaupel says, “There are lots of places with clean air, water, good food and exercise … and in many of those regions people live short lives.”

In fact, a 2012 study conducted by researchers affiliated with both Chinese and American universities suggests that the longevity of Bama’s residents may have nothing to do with location ­– unless you count natural selection. Locals who have thrived in this remote region seem to have passed on unique DNA that could contribute to longer life. (How long, of course, is uncertain.)

None of this seems to discourage visitors to Bama’s “longevity village,” or the businesses that cater to them. Almost four million people came to the region in 2015 alone, generating about $570 million U.S. in revenue.

“Buses of Chinese tourists (arrive) in droves,” says Stephen Cram, an Australian who owns an agritourism business in the region. “In the past year, a lot of upgrading has taken place, with high-speed internet available, new highways built and services improved.”

All that development may actually erode the few benefits – that clean air and water – that do exist for locals. Growing wealth and access to technology can also negatively impact residents’ diets (as they switch to richer, processed foods) and exercise (using a car instead of walking) Poulain has seen the same thing among locals is the four legit “blue zones” he identified as they’ve been modernized.

Still, as long as the promise, however shaky, of healthy old age remains, those tourists with their little red envelopes will keep coming and the “centenarians” will keep greeting them.

The provocative blog post by a foreign Islamic scholar drew strong rebukes this week from researchers and advocates concerned about female-genital mutilation, and from a major Jewish group.

It also resurrected questions about whether genital cutting of young women is taking place in Canada, despite being a crime punishable by up to 14 years in prison.

The essay advocates only removing the prepuce, or layer of skin, over the clitoris, calling it similar to taking off the foreskin in male circumcision. But all forms of female genital cutting have been outlawed here since 1997.

One expert on FGM said she’s worried the authoritative-sounding article could send the wrong message to Muslim families.

“It’s putting a burden on these parents, because now they are having to choose between maintaining adherence to (the author’s views), versus the Criminal Code,” said Corinne Packer, a senior researcher with the University of Ottawa’s School of Epidemiology and Public Health. “Any cutting of the genitalia for non-medical reasons is prohibited — it has been prohibited for 20 years.”

The council, the 80,000-strong community’s elected body, said Thursday it actually has nothing to do with the site, and condemned the Jewish references in the article.

An initial statement supplied by a council official voiced support for the limited type of circumcision the blog promotes, saying it enabled women to experience more sexual pleasure. But the group issued another comment Friday, saying the original one was the opinion of a single individual and not approved by its leaders. The new message states the council was “extremely perturbed” by the article and that Islamic law forbids all types of female genital surgery.

The website is operated by individuals who are in an “adversarial relationship” with the council, the statement said.

The post by Asiff Hussein, affiliated with the Centre for Islamic Studies in Sri Lanka, promises to explain “how misogynists and feminists are feeding upon each other to denigrate an Islamic practice that brings untold benefits to women.”

It says circumcision should only involve removal of the clitoral prepuce, a procedure it says leads to enhanced sexual enjoyment for women, and argues it is endorsed by the Hadith, sacred interpretations of the Prophet Mohammed’s words.

Hussein said Islam forbids the more severe forms of genital mutilation practiced in Africa, but the truth about female circumcision has been obscured by “Islamaphobic sentiments expressed by a largely Jewish-controlled media.” Jews also want to hide the fact that limited female circumcision is another “feather in the cap” of Islam, the article says.

But the variety of health groups that have condemned genital cutting, citing its often-serious physical and emotional impacts, include removing the prepuce in their definition of the act.

The World Health Organization classifies the procedure as a type-one form of mutilation, on a scale of severity that extends up to type four.

There has been some debate within the medical community lately about whether this form of cutting does constitute mutilation, said Els Leye, a professor in the International Centre for Reproductive Health at Belgium’s Ghent University.

But there’s no guarantee the circumcizer won’t go further, and advocating it as a religious rite could legitimize the whole concept of genital mutilation, said the leading FGM expert.

“It doesn’t have any health benefits, of course,” Leye said. “Circumcising women is clearly something that impacts on their sexuality, on their right to bodily integrity … It’s very difficult to maintain that it is harmless.”

Meanwhile, a Jewish group voiced dismay that the article was “littered with classical anti-semitic tropes.”

“To gratuitously implicate Jewish people in the discussion is unnecessary and disturbing,” said Jared Shore of the Calgary Jewish Federation.

Citing census data on families from countries where FGM is common — including Sudan, Somalia and Egypt — Packer and a colleague have estimated that 5,572 Canadian girls are at risk of being subjected to the practice.

But little is done to advertise the criminal ban in Canada and, unlike in other Western countries, there is no attempt to track how often it might occur here, she said.

(This story was modified on Sept. 8 to reflect a revised statement from the Muslim Council of Calgary.)

]]>http://nationalpost.com/health/calgary-muslim-website-defends-female-circumcision-and-critiques-jewish-media/feed4AFP_OB0O7blackwell2001Apollo Applied Research a trailblazer in medical cannabis researchhttp://nationalpost.com/health/apollo-applied-research-a-trailblazer-in-medical-cannabis-research
Thu, 07 Sep 2017 16:02:05 +0000http://nationalpost.com/?p=76450381]]>Bryan Hendin co-founded a pain clinic in Toronto in 2012, hoping to ease patients’ suffering. He had no idea that he would become a trailblazer in the medical cannabis space, overseeing groundbreaking research.

As that pain clinic thrived, more patients walked through the door singing the praises of cannabis. They had been using it to treat pain associated with numerous conditions, ranging from chronic headaches to herniated discs and arthritis. But they were frustrated. Medical cannabis was already legal but top pain specialists wouldn’t prescribe it. There wasn’t’ enough scientific evidence to support these patients’ claims.

That spurred Hendin to action. He set out to “prove or disprove the effectiveness of cannabis as a treatment,” he recalls. “It just felt like something I had to do.”

In 2013, he established Apollo Applied Research to conduct studies looking at the possible benefits of medical cannabis and determining the most effective strains to treat various medical conditions. Soon, a small group of the top academic pain doctors were willing to help Hendin start conducting Apollo’s clinical research.

To accelerate research Hendin opened a clinical division of Apollo called Apollo Cannabis Clinic in 2014. Starting with less than a handful of doctors who would prescribe, to date, over 100 doctors across Canada support Apollo. Today, Apollo is not only conducting cutting-edge clinical research on chronic pain, but also helping patients directly.

Apollo’s findings, all reviewed and supported by physicians, have been published in peer-reviewed medical journals. The Apollo team, which includes seven full-time researchers, regularly presents at medical seminars and conferences. Earlier this year, Apollo’s research was presented at NYU Grand Rounds, Department of Pain.

These findings have convinced more doctors to refer patients to Apollo and have made more patients open to using cannabis to treat their pain. In the past three years, more than 10,000 patients have been prescribed medical cannabis for various conditions at Apollo.

Each patient has received a personalized treatment plan and has met with a patient educator. “Not all strains of cannabis are the same. We’re learning every day which strains work for which conditions and for which patients,” says Hendin. “We love passing on to patients the knowledge we gain through our research.”

What accounts for Apollo’s success? “We’re Canada’s original cannabis research clinic,” Hendin explains. “We’ve set the gold standard for [cannabis] therapy.”

In one of Apollo’s most ambitious undertakings to date, it launched a study analyzing the effects of medical cannabis on patients with PTSD. Through the study, which was launched last year, researchers hope to find ways to lessen PTSD symptoms including flashbacks nightmares, estrangement, detachment from others, paranoia and sleep disturbance.

“This research study is a passion project and it is timely, given the national attention that is being given to veterans, first responders and to mental health awareness overall,” says Hendin. “There has been a lot of anecdotal evidence and now it’s time for validated research.” In preliminary findings of Apollo’s PTSD study, Apollo PTSD patients saw a 77% improvement in PTSD symptoms, such as social functioning.

“We’ve changed the lives of so many people,” says Hendin. “It’s truly incredible.”

To learn more about Apollo’s Research or eligibility requirements for medical cannabis, please email info@apolloresearch.ca or call toll free at 1-877-560-9195.

This story was created by Content Works, Postmedia’s commercial content division, on behalf of Apollo Applied Research.

]]>Bryan_NationalPost-FeaturespecialnpDoctors denying ‘tubals’ to women under 30 opting out of motherhoodhttp://nationalpost.com/health/doctors-denying-tubals-to-women-under-30-opting-out-of-motherhood
http://nationalpost.com/health/doctors-denying-tubals-to-women-under-30-opting-out-of-motherhood#commentsWed, 06 Sep 2017 17:47:19 +0000http://nationalpost.com/?p=76464673]]>Dr. Dustin Costescu’s name appears on a list of doctors on a Reddit forum willing to perform what many others apparently will not: “tubals” — permanent sterilization — on 20-something women convinced they do not want to have children, ever.

Costescu, a family planning specialist and assistant professor at Hamilton’s McMaster University, says any woman wishing to prevent pregnancy permanently, and who has no contraindications, or medical reasons why she shouldn’t be sterilized, should be considered appropriate for the procedure.

In fact, Canadian professional guidelines are clear: In a well-informed, mentally competent woman who understands her birth control options and the “permanency of the procedure,” sterilization should be offered regardless of age or parity, meaning whether or not she’s given birth, Costescu and his co-author Dr. Dylan Ehman write in an article published online ahead of print in the Journal of Obstetrics and Gynaecology of Canada.

However, “many women who desire sterilization at a young age experience barriers from physicians who decline to facilitate the request,” they report.

In a small case series, the authors reviewed the medical records of 29 women under 30 who had, or were on a waitlist for, sterilization at Costescu’s clinic. Most reported that when they first sought sterilization, doctors either refused to perform the procedure or refused to refer the women to a willing provider.

Some women said they were advised to seek a psychiatric evaluation, implying that it’s somehow “pathological” to want to opt out of motherhood, Costescu said.

He blames a “well intentioned paternalism” among doctors as well as inherent gender bias that women are meant to be mothers.

“Because my name happens to be on a Reddit board, and because of other articles, I’m getting more referrals from women seeking this,” Costescu said in an interview. The childfree forum contains posts like, “Article criticized UK for cutting off tax credits for 3rd child: Is that really a bad thing?,” “How can I convince my Mom that being childfree is a perfectly reasonable life decision?” and a post from New York Times reporters “looking to hear from women who regret having a child.”

There’s not a lot of longitudinal data to know whether more under-30s are seeking sterilization. “It’s unclear if this is more women choosing to be childfree,” Costescu said, “or increased comfort in advocating” for sterilization.

The surgery involves putting clips across the fallopian tubes via laparoscopic surgery, or removing a portion, or all of the tubes entirely, to prevent an egg from reaching the uterus and being fertilized.

With a traditional “tubal” the fallopian tubes can be reopened, untied or reconnected. However, a reversal doesn’t guarantee pregnancy and, in most areas, the $8,000 to $12,000 procedure is not covered. Another option is in vitro fertilization, or IVF, which can run $10,000 to $20,000 per cycle, Costescu said.

In the McMaster study, some of the women had medical conditions that could make pregnancy risky. Others already had two or more children and were certain they didn’t want another. About a third had never borne a child.

“Often these women have other role models in their life who are also childfree,” Costescu said. “They may be aunts or people in senior positions in their workplace — role models who demonstrate they can meet all of their other life goals without having children.”

Sterilization is generally safe and effective, he and Ehman write. Surgical risks include bleeding and infection, though the complication rate is less than two per cent. The 10-year failure rate ranges from less than one per cent, to five per cent among younger women. It’s a minor surgery performed under full anesthetic.

The most common risk is regret.

One U.S. review involving more than 11,000 women who underwent permanent sterilization in the 1970s and 1980s found that, after 14 years, the cumulative risk of regret was 20 per cent among those who were 30 or younger when they were sterilized, and six per cent for women over age 30 at sterilization.

However, regret was lower in women who had never had a child, compared with women with at least one, suggesting “a woman who is child-free and wishes to remain so is less likely to regret sterilization than a mother who wants no additional children,” the McMaster duo write in the JOGC. “Therefore, declining to refer or provide permanent contraception because of the risk of regret is a decision based on conscience and not evidence.”

(As an aside, they point to another study looking at major life milestones that found the fourth most common major life regret reported by Americans was becoming a parent.)

“I personally have zero worries about the risk of regret,” said a 26-year-old woman scheduled for a tubal ligation later this month at McMaster University Medical Centre. “I actually don’t remember a time when I’ve had a parental instinct (other than with animals),” she said in an email.

The woman, a small business owner in the Niagara Region who asked not to be named, said she has experienced “the typical comments about how I’ll change my mind, and that I’m ‘too young to know what I want.’ I’ve had doctors, all men, simply laugh off the situation and my concerns and tell me I’m not ready to make that decision (even though I have medical issues with my uterus and cervix).”

Her partner, she added, fully supports her desire to be child free.

Still, female sterilization has a horrid history. “In much of the 20th century, providers engaged in coercive sterilization of women from certain social locations” including Indigenous women and women with disabilities, they write. This past July, the Saskatoon Regional Health Authority released the report of an independent inquiry into Indigenous women who were coerced into being sterilized in the hours after giving birth in the city’s hospitals.

Costescu sees parallels between the forced sterilizations of Indigenous women and younger women being denied voluntary sterilizations because of paternalistic beliefs.

“In the case of Indigenous women, you are restricting women’s access to fertility. In this case you are supposing that all women must have children and women who choose childfree living are somehow making a bad decision,” he said. “They’re really two sides of the same issue.”

In the past, professional bodies advised restricting sterilization to women 30 and over, or using the “120 Rule,” in which a woman’s age, multiplied by the number of her children, had to total 120 or greater.

While new Canadian guidelines (which Costescu helped author) recommend no restrictions on the basis of age, Costescu said other doctors told many women in his practice they had to wait until they were 30. Today, the median age of first childbirth approaches 30, “which makes this number even less meaningful — half are still childless at this age.”

Years later, the Alberta-based health policy expert still believes the actress-turned-wellness entrepreneur is wrong, about so many things.

But he’s heartened by the prospect of increased scrutiny over Paltrow’s lifestyle brand and website, Goop, now in the crosshairs of the U.S. watchdog group Truth in Advertising.

“I loved it when I heard this was happening with Gwyneth,” Caulfield admits in a recent call from Edmonton, where he is a professor at the University of Alberta and a Canada research chair in health law and policy.

“Really, I think that’s great, great news. Now, whether it will work is another question but I just think it’s fantastic that the attempt is being made and it’s highlighting how this is not accurate.”

Truth in Advertising has called on California regulators to investigate Goop for using “unsubstantiated, and therefore deceptive” claims to promote its health products.

The Connecticut-based non-profit, which fights false advertising and deceptive marketing, sent a complaint letter to two district attorneys on the California Food Drug and Medical Device Task Force, urging “appropriate enforcement action.”

Paltrow shot back on the podcast Girlboss Radio, suggesting critics are really targeting women’s rights: “There’s something that feels inherently dangerous to people about women being completely autonomous” in their sexual and psychological health, she told interviewer Sophia Amoruso.

“Her response drove me absolutely nuts,” says Caulfield, a longtime critic of Goop’s claims that its products can treat, cure, prevent, or alleviate the symptoms of various illnesses including depression, infertility and arthritis.

“She keeps pushing this idea that Goop is about autonomy and anyone who questions the science is somehow infringing on women’s autonomy. Which of course is absolutely absurd because just look at it from an informed consent perspective: Misleading people is not enhancing autonomy. She’s actually eroding autonomy by providing information that is misleading…. We want accurate information. We don’t want misleading information and we don’t want the spreading of bunk.”

Combating bunk is the main premise of his new six-part TV series for VisionTV, “A User’s Guide to Cheating Death,” starting Sept. 18.

In it, Caulfield travels the world to expose the truth behind buzzy health trends that promise a better you, include detox diets, juicing, “anti-aging products” and genetic testing.

Along the way he speaks to experts including Joe Schwarcz, director of the office for science and society at McGill University who concludes: “The quacks will always have a solution. It will be simple. It will be wrong.”

A lot of these products are harmless, but the fact they are sold as if backed by real science can lead to a misinformed public, says Caulfield. That undermines our general understanding of science and can steer people away from real treatments that do help, he fears.

Caulfield turns to his friend and fellow Goop-debunker Dr. Jennifer Gunter for help in dismissing two Goop-endorsed practices — colonics and vaginal steaming. Both are unnecessary, and both carry risk of harm, declares Gunter, a Winnipeg-born OB/GYN now practising in the U.S.

Caulfield says he considered pursuing an interview with Paltrow for the TV series, but didn’t think she’d agree. He notes he reached out repeatedly while working on his book but never got a response.

Paltrow has lashed out at her critics, especially Gunter, through Twitter and on Goop, but Caulfield suspects all the controversy actually strengthens her brand and galvanizes her devotees.

“I used to think maybe she really believed this stuff…. That was going to be my one question to Gwyneth,” he says, choosing a more cynical take that it’s purely business.

“All this pushback helps her cultivate that sort of outsider brand that ‘we’re about being open-minded and trying new things and you science-y people are all about shutting down new ideas.’ Which of course isn’t the case at all.”

He admits to being frustrated by so much health information being twisted and confused in popular culture.

But he’s fascinated by the fact that otherwise reasonable people will believe unbelievable claims.

“I don’t think it’s right to blame individuals for making crazy decisions. This is a really complex phenomenon that involves a lot of systemic pressures,” says Caulfield.

Some people feel like conventional medicine isn’t meeting their needs, he allows, and perhaps the medical establishment isn’t doing enough to simply listen to patients’ fears and concerns, he muses. There are definitely trust issues, says Caulfield.

“Clearly something is missing,” he says.

“This is filling some kind of need for these people. They believe it works, and we even had some individuals in the later episodes say, ‘I don’t care if it’s a placebo effect, this is something that is meaningful to me.’ We need to learn from that.”

In an awful way, it all made perfect sense, Gail T. Wells remembers thinking as neurologist Thy Nguyen matter-of-factly explained that she was ordering tests to check for an underlying cancer.

Cancer would explain the worsening symptoms – abdominal pain, incessant cough, weight loss and crushing fatigue – that had plagued Wells, to the puzzlement of her doctors.

“I felt like I was dying,” said Wells, a nurse practitioner, of her initial meeting in February 2016 with Nguyen, an assistant professor of neurology at the University of Texas Health Science Center in Houston. “I really wasn’t surprised. It was more like a kind of resignation.”

But it was a resignation punctuated by icy stabs of fear, as Wells quickly underwent a mammogram and other scans in an effort to pinpoint where a malignancy might be lurking. She broke the news to her husband and their four grown children, reviewed her funeral arrangements and tried to steel herself for what lay ahead.

Four days later, the neurologist called. Wells’s bloodwork showed no sign of cancer. In fact, most tests were normal. But one revealed a long-standing problem Wells had never known about.

“You could have told me I was pregnant, that’s how astonished I was,” recalled Wells, who was then 62.

Now that her medical problem has been identified and treated, Gail Wells says she feels “a renewed appreciation for life every waking hour”

The finding proved to be the key to her diagnosis and subsequent successful treatment. The possibility had been repeatedly overlooked because Wells had not shown the manifestations common to someone with her condition.

In 2005, after years of working in hospitals, Wells founded a primary-care clinic in Houston to treat people who were uninsured or underinsured.

She had long thrived on a pace others might consider grueling: 12-hour workdays during which she was often too busy to eat. To stay in shape, she ran and worked out regularly. Her only notable health problem was sporadic migraines.

About 15 years ago, after taking a powerful anti-seizure drug used to treat migraines, she developed numbness, or neuropathy, in her toes. The problem abated when she stopped the drug, but it never entirely disappeared.

In 2010, Wells developed heartburn and, later, a chronic cough, which she attributed to acid reflux.

In 2013, when her husband retired, Wells did, too. She sold her clinic, and the couple decided to spend more time traveling. Over the next two years, they visited Portugal, Spain, Italy and the Caribbean, trips that Wells found increasingly joyless and difficult. She noticed that normal activities, such as walking for exercise in her neighborhood, were becoming physically taxing.

She and her husband thought that she might be depressed. Wells had been busy for so many years that, once retired, she had relatively little with which to fill her days. To counter her malaise, she took a few graduate medical courses and registered with an agency for temporary nursing jobs.

Neither helped. Her fatigue worsened, and she found interacting with people increasingly exhausting. Some days, she didn’t have the energy to get out of her pajamas.

Wells also developed an odd new problem. Once or twice a month, she would awaken from a sound sleep with intense abdominal cramps. Vomiting would sometimes relieve the pain, which typically disappeared after about eight hours, leaving her feeling wiped out.

Wells had also lost about 10 pounds between 2013 and 2015, which she attributed to better eating habits and the elimination of the two glasses of red wine she habitually drank after work. Because unintended weight loss can be a sign of underlying illness – including cancer – her primary-care doctor ordered tests to check her liver, kidneys and pancreas.

Everything looked normal. The doctor recommended that she see a gastroenterologist. Wells had never undergone a colonoscopy, which is recommended at age 50 for people at normal risk.

“I’m a big chicken,” she said.

But in August 2015, before she made a gastroenterology appointment, Wells experienced an unnerving episode. Her left leg and lower lip suddenly went numb, and her tongue began tingling. Wells said she didn’t think she was having a stroke because she could think clearly; the symptoms abated within hours. She saw a neurologist, who suspected multiple sclerosis or a vitamin B deficiency, both of which were soon ruled out. But a nerve conduction test, which uses electrodes attached to the skin to assess damage, showed decreased rates of nerve conduction in her left leg and both feet.

Because no underlying cause could be found, Wells was diagnosed with idiopathic degenerative neuropathy – nerve deterioration for no apparent reason – and advised to stay physically active to preserve muscle function.

That became increasingly difficult.

During Houston’s mild winters, her feet felt constantly numb and cold, like “blocks of ice.” She wore wool socks around the clock and slept beneath an electric blanket and two comforters. Her cough worsened, and Wells periodically felt short of breath, even though a chest CT scan and a TB test were normal.

“I felt like I was aging super-fast,” she said. “I thought, ‘How do people manage in their 70s and 80s?'”

In February 2016, she consulted Nguyen for a second opinion.

“I remember she was tearful,” Nguyen said. “She said, ‘I’ve been looking forward to retiring, and now I can’t do anything.’ ” Her neurological exam, Nguyen added, was consistent with the weakness she described.

Nguyen decided to repeat the nerve conduction test, which showed a significant worsening. “Things were going kind of fast, and that’s very unusual,” Nguyen said. “At that point, you have to start thinking out of the box.”

The neurologist ordered sophisticated blood tests. Among the most likely culprits, she thought, were a paraneoplastic syndrome (whose symptoms are caused by substances circulating in the blood in response to a cancer), elevated levels of vitamin B6 or Sjogren’s syndrome, an autoimmune disorder that attacks mucous members and joints.

Four days later, Nguyen received the results of Wells’s blood tests.

“I was pretty surprised – and I was nervous to call her” to break the news, the neurologist recalled.

There was no sign of an underlying cancer. But Wells was clearly infected with hepatitis C, a potentially fatal disease that can cause liver cancer.

For reasons that aren’t clear, hepatitis C is most common among the members of Wells’ generation: baby boomers born between 1946 and 1964. It is also an occupational hazard for health-care workers, the result of accidental needlesticks or other contact with a patient’s infected blood. Before 2014, there were no oral medicines specifically approved to treat hepatitis C, which was discovered in 1989.

“I was gobsmacked” by Nguyen’s news, Wells recalled. She knew, and had told all her doctors, that she had been exposed to another infection, hepatitis B, years earlier, most likely in 1983 while working in an emergency room on a drug dealer who was bleeding profusely after a machete attack. Days after the incident, she had tested positive for hepatitis B. Like 95 per cent of adults, Wells cleared the virus from her system and then became immune to hepatitis B.

But most adults are unable to clear hepatitis C from their bodies and unknowingly go on to develop a serious, chronic infection that can fester for years, damaging their livers.

Wells suspects she was exposed to hepatitis C during the same incident because co-infections were common in those days.

But her liver function tests had always been normal.

So what exactly was the cause of her symptoms?

Wells turned out to have a rare disorder caused by hepatitis C known as Type 2 mixed cryoglobulinemia.

It occurs when cryoglobulins – abnormal proteins in the blood – thicken and clump together, restricting blood flow to surrounding organs and causing damage to blood vessels. Cryoglobulins often develop in response to hepatitis C or an autoimmune disorder; roughly half of those with a chronic hepatitis C infection are believed to have cryoglobulins circulating in their blood, but fewer than 30 percent of them develop symptoms. Those signs include fatigue, abdominal pain, weakness, neuropathy and Raynaud’s disease, a reaction to cold temperatures or stress that can result in a narrowing of blood vessels. Cryoglobulinemia is three times as common in women as in men. Most cases have been reported in those between ages 40 and 60.

“It’s the most common manifestation of hep C outside the liver,” Nguyen said. “In Europe, it’s more commonly recognized.”

The disorder was overlooked, Nguyen speculated, because Wells’ symptoms – abdominal pain, numbness, fatigue – are common to many other diseases. And before Nguyen, no doctor had ever thought to screen Wells for hepatitis C.

Wells consulted a liver specialist, and in the summer of 2016 began a 12-week course of treatment with Harvoni, a medicine that costs about $92,000 and is considered to effectively cure hepatitis C. The cryoglobulin count in her blood steadily decreased, and by April of this year it was undetectable. (Although doctors didn’t know at the time that Harvoni could reactivate her hepatitis B, Wells suffered no such complication.)

Nearly all of her symptoms, except the leg numbness, disappeared.

“I was just so relieved to have a cause,” she said, “and so blown away that we actually had a cure.” She is especially relieved that her family tested negative: Hepatitis C can sometimes be transmitted during childbirth and to those who live in the same house.

Wells says she feels “a renewed appreciation for life every waking hour.” Her energy level has rebounded, and she feels well enough to take week-long out-of-town work assignments.

She wonders how many other people might have simmering hepatitis C infections or cryoglobulinemia, without knowing it.

“If I had not had hepatitis B,” she said, “would anybody have found this?”

—

Video: Gail Wells was diagnosed with hepatitis C and a rare condition that she says could have killed her. (Patrick Martin/The Washington Post)

]]>http://nationalpost.com/health/she-thought-her-mystery-ailment-was-cancer-but-bloodwork-revealed-a-surprise-i-was-gobsmacked/feed0qw_MEDICAL-MYSTERYnpwapoGrey Matters: Quality of life will suffer further unless we toughen up and take actionhttp://nationalpost.com/health/seniors/grey-matters-quality-of-life-will-suffer-further-unless-we-toughen-up-and-take-action
http://nationalpost.com/health/seniors/grey-matters-quality-of-life-will-suffer-further-unless-we-toughen-up-and-take-action#respondMon, 04 Sep 2017 12:00:29 +0000http://nationalpost.com/?p=76409168]]>By Wanda Morris

Scott Terrio, an estate administrator with licensed insolvency trustee Coopers and Co., has seen too many debtors ignore clear signs of financial peril. They keep trying to make minimum credit card payments, prop up failing businesses, or hold on to a family home as their problems mount. By the time they seek help, many of their options have disappeared. If only they’d seen Terrio earlier, he might have saved their house — or their marriage.

We don’t just refuse to face facts when it comes to our finances; many of us are guilty of ignoring the reality that we are aging, too. Nobody wants to know that their hearing or eyesight is getting worse, much less that they are losing mobility or bladder control. But these problems rarely get better without help. Like financial crises, the longer we take to deal with them, the more limited our options become.

In extreme cases, ignoring failing body parts can magnify the harm and even cause premature death. My father died 16 years ago after his prostate cancer metastasized. If he’d obtained an earlier diagnosis, my son might have had a chance to know his granddad.

Wilful denials don’t usually end up killing us, but our quality of life can suffer significantly. We may refuse invitations because we’re afraid of a bladder leak, avoid conversations because we don’t hear well, or limit our walks because of mobility issues. These self-imposed restrictions are largely avoidable.

Technology has improved markedly over recent decades. Many aids to daily living are discreet to the point of invisibility, and where size precludes discretion, clever and stylish options abound. But it’s hard for product manufacturers to get the word out.

At CARP and our sister organization, ZoomerMedia, we periodically send emails to our members and magazine readers about products and services we think they’ll like. To understand what content is of greatest interest to our members, we track the number of times emails get opened and the unsubscribe requests they generate. Whether it’s step-in bathtubs or ride-on stairlifts, no content gets a higher rate of unsubscribes than emails featuring a product or service designed to help us deal with the fallout of aging.

This is too bad. By ignoring our problems and running away from potential solutions, we not only deny ourselves help, but we send a message to potential inventors and entrepreneurs that our problems aren’t worth solving. Even when they find creative and clever solutions, we don’t want to know about them.

That has to change. My friend, Trish, has a sign on her kitchen wall that reads: “Put your big-girl panties on and deal with it.” For readers who don’t wear panties, the equivalent expression is “cowboy up:” toughen up and do the best you can with the hand you’re dealt.

We need to toughen up, face reality and start taking advantage of the products and services that will make our lives better. For starters, anyone reading this who is not yet a CARP member should join and take advantage of our great member discounts on products from walking poles to invisible bifocals. (Yes, you can also check out our deals on hotels and car rentals while you’re there.)

Old age is a privilege denied to many. It’s time for the rest of us to put on our big-girl panties or cowboy up and make the best of it.

Wanda Morris is the VP of Advocacy for CARP, a 300,000-member national, non-partisan, non-profit organization that advocates for financial security, improved health-care and freedom from ageism for Canadians as we age. Send questions to askwanda@carp.ca. To join CARP or learn more, call 1-800-363-9736 or visit carp.ca